Free antibiotics hurt patients

If you have been near a pharmacy at your local supermarket
lately, then chances are that you have heard about the newest
advertising tool for these stores: Free antibiotics. The concept is
simple enough. The pharmacy absorbs a small financial loss on the
antibiotics, but more than makes up for this loss through your
other purchases around the store. In the process, it may also
convince you to transfer your prescriptions over from its
competitors. On the surface, this quid pro quo appears to be a
win-win situation that gives patients more access to medications
while bolstering store sales. While this strategy does make certain
drugs more affordable, it also has great potential to hurt
patients.

First of all, free antibiotics — or in a more general sense,
free anything — promotes moral hazard and overuse, leading to
resistance and unnecessary side effects. Imagine that you just got
a sore throat and mild fever. What would you normally do? I think a
fair assumption would be to get a bit of extra rest and rely on
your own immune system and possibly some over-the-counter
medications to relieve the problem. If the symptoms do not seem to
get better after a few days, then you might pay a visit to your
doctor to get a check-up and prescription.

With the advent of the free antibiotics programs though, you
might very well be more inclined to make that doctor's visit
earlier and skip the natural defense step altogether. And while
this program does not cover all the antibiotics on the market, the
inclusion list is quite comprehensive and provides up to a 14-day
supply of many of the most commonly prescribed ones — including
amoxicillin, cephalexin and Cipro. So chances are that your
prescription will be covered.

But by rushing to antibiotics as the first-line solution at the
first possible sign of illness, you are subjecting your body to
antibiotic resistance, which occurs when the bacteria mutate in
ways that makes them more resilient to medications. Antibiotic
resistance has become more and more of a public health burden in
recent years, aided by its pervasive use in raising livestock as
well as its general overuse in society. Staph infections — which
were largely treatable with penicillin in the past — are showing
increasing resistance against these drugs and newer antibiotics as
well. Clinicians today often find themselves depleted of all
treatment options due to resistance and can only watch helplessly
as their patients wither away. The economic cost of this crisis is
currently estimated at $4 billion per year, but no price tag can be
attached to its physical and emotional toll. Simply put, we already
get enough antibiotics from the meat we eat; there's no need to add
to that by freeloading at the local pharmacy.

In addition to causing resistance, antibiotics also cause many
side effects, most of them rare, but all of them unworthy of the
risk if the drugs are unnecessary. Take amoxicillin for example.
Many who have taken this medication have experienced some degree of
upset stomach, which is a common side effect of this drug. But a
look at its package insert reveals the following non-exhaustive
list of additional side effects: Agitation, anemia, anxiety,
changes in behavior, colitis, confusion, convulsions, diarrhea,
dizziness, hives, hyperactivity, insomnia, liver problems and
jaundice, peeling skin, rash and tooth discoloration in children.
It should be emphasized that these side effects are quite rare, but
the length of this list alone should convince you that these drugs
are not without their risks and should be taken prudently.

Besides promoting over-medication and the associated
complications and side effects, free antibiotic programs also lead
to significant gaps in health care delivery through the
fragmentation of a patient's medication records. Under normal
circumstances, patients tend to get all of their prescriptions from
a single pharmacy. Not only is this arrangement logistically
convenient for the patient, it also allows for optimal care by
allowing the pharmacist to ensure that the drugs being prescribed
are appropriate given the patient's drug regimen, allergies and
other health information.

The extensive didactic and clinical training that all
pharmacists go through enables them to detect drug interactions,
inappropriate doses and other potential medication errors and work
with the patient's physician or nurse to rectify the situation. For
example, if a patient is allergic to penicillin, he should not only
avoid amoxicillin — an antibiotic in the penicillin class — but
possibly also cephalexin and certain other drugs as well.

While pharmacists can contribute significantly to a patient's
well-being, this contribution is contingent on the pharmacist
having access to a patient's entire medication record, which is not
easily accessible between different pharmacy chains. Therefore, if
a patient usually gets theophylline — an asthma medication — from
the local Rite-Aid and decides to take advantage of ShopRite's free
antibiotic program by getting a 14-day supply of erythromycin at
the store, neither the pharmacist at Rite-Aid nor his counterpart
at ShopRite would be aware of the other drug being taken unless the
patient told them this information.

Unfortunately, either due to neglect on the part of the
pharmacist to ask or on the part on the patient to tell, this
exchange often does not occur, and the interaction that results
between these two drugs — which causes an increase in the level of
theophylline in the body — can provoke abnormal heart rhythms,
seizures, and ultimately, a lengthy and bitter litigation process.
Widespread adoption of electronic health records, as mandated by
the new health care law, will help to confront this issue through
more comprehensive and accessible medication and health records,
but we are still many years from reaching that point.

So while these free antibiotic programs popping up in a
supermarket near you are laudable in increasing accessibility, the
bottom line is that they pose more harm than good to society.
Contrary to what is implied by these gimmicks and professed by some
economists, health care is not a commodity — getting your
prescription is not the same thing as buying, say, a DVD. If you
picked up "Pineapple Express" and realized that it did not suit
your taste, than the worst that can happen is that you lose a
couple of hours of your life and about $20. If you get an
antibiotic that was either unnecessary or that interacted with one
of your other medications, then you risk life-threatening
complications. In medicine, the clinical services and judgments
provided by health care professions are as important — if not more
so — to optimal patient care as the drug itself, and trying to
commoditize healthcare prevents them from being rendered
appropriately.

Bo Wang is an Ernest Mario School of Pharmacy sixth-year student
and former president of the Pharmacy Governing Council. His column,
"Doctor's Orders," runs on alternate Mondays.